POS0768 PRESENCE OF ANTI-Ro/SSA AUTOANTIBODIES, HYPOCOMPLEMENTEMIA AND PHOTOSENSITIVITY INDICATE INDIVIDUALS WITH CONNECTIVE TISSUE DISEASE FEATURES WHO ARE AT INCREASED RISK FOR TRANSITION TO SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: E. Emmanouilidou, C. Adamichou, M. Nikoloudaki, E. Kalogiannaki, A. Repa, N. Avgustidis, A. Eskitzis, N. Kougkas, P. Sidiropoulos, G. Bertsias
Journal: Annals of the Rheumatic Diseases (2022)

Background Early or pre-clinical forms of lupus encompass a broad range of presentations, spanning from asymptomatic individuals with immunological abnormalities to individuals with autoantibodies and some features suggestive of SLE who do not yet meet the classification criteria. Research on this topic could reveal predictive and diagnostic biomarkers for individuals at-risk for progression to SLE. Objectives To examine the rate of transition from at-risk to classified (ACR 1997 criteria) SLE, and identify demographic and clinical predictors. To prospectively evaluate the sensitivity and accuracy of the newer classification criteria (SLICC 2012, EULAR/ACR 2019) and the SLE Risk Predictive Index (SLERPI)[1] in patients at-risk who progress or not to classified SLE. Methods This is a single-centre analysis of individuals at-risk for SLE as part of an ongoing multicentric inception cohort study aiming to identify clinical, environmental and molecular prognostic factors for SLE onset. Enrolled individuals: a) were 18–55 years old; b) had clinical and/or serological features suggestive of SLE; c) had no clinical diagnosis of SLE or other autoimmune rheumatic disease; and d) did not fulfill the ACR 1997 classification criteria. Prospective monitoring at 6-month intervals was performed to determine accrual of classification and non-classification features, and ascertain the disease status (at-risk/undifferentiated connective tissue disease, SLE, other connective tissue disease). Results A total 124 subjects were included, all Whites, 94.4% women, with an average (standard deviation) age 36 (11) years. At first assessment, individuals fulfilled 2.25 (0.72) ACR 1997 criteria with ANA being the most prevalent feature (75.8%) followed by low complement (43.5%), arthritis (37.9%), photosensitivity (28.2%), malar rash (23.4%), and non-scarring alopecia (18.5%). After a median follow-up of 16 months, 27 participants (21.8%) fulfilled the ACR 1997 criteria, of whom 8 (6.5%) developed moderate or severe SLE. Multivariable-adjusted logistic regression identified anti-Ro/SSA (odds ratio [OR] 6.93; 95% confidence interval [95% CI] 1.75–27.5, p=0.006), combined low C3 and low C4 (OR 4.82; 95% CI 1.42–16.3, p=0.012) and photosensitivity (OR 3.25; 95% CI 1.17–8.99, p=0.023) as independent predictors for transition to classified SLE. The sensitivity of SLICC 2012, EULAR/ACR 2019 and SLERPI (&gt;7) at baseline for detecting individuals who progressed to SLE (ACR 1997) was 40.7%, 25.9% and 40.7%, respectively, with corresponding specificities of 83.5%, 88.7% and 79.4%. Conclusion Among individuals at-risk for SLE, about 20% may evolve into classified disease after a medium follow up of 16 months which is predominantly of mild severity. Presence of anti-Ro/SSA, hypocomplementemia, and photosensitivity indicate subjects who at increased risk for transition to SLE. Newer classification systems may capture as many as 40% of progressors with acceptable specificity. References [1]doi: 10.1136/annrheumdis-2020-219069 Acknowledgements This work was funded by the Foundation for Research in Rheumatology (FOREUM). Disclosure of Interests None declared